• KimuraShun-IchiSDivision of Hematology, Saitama Medical Center, Jichi Medical University, Saitana, Japan., Kumi Oshima, Ken Sato, Miki Sato, Kiriko Terasako, Hideki Nakasone, Misato Kikuchi, Shinya Okuda, Shinichi Kako, Rie Yamazaki, Yukie Tanaka, Aki Tanihara, Junji Nishida, and Yoshinobu Kanda.
• Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitana, Japan.
• Biol. Blood Marrow Transplant. 2010 Oct 1; 16 (10): 1355-61.

AbstractWe investigated the impact of neutropenia on the development of early bloodstream and pulmonary infections in hematopoietic stem cell transplantation (HSCT) recipients, and evaluated the utility of an index (D-index) that reflects both the intensity and duration of neutropenia. Fifty-eight patients (23 autologous, 35 allogeneic HSCT recipients) were enrolled in this retrospective study. The D-index was defined as the area over the neutrophil curve during neutropenia. We also evaluated the utility of the cumulative D-index from the start of neutropenia until the development of infection (c-D-index), which may enable real-time assessment of the risk for infection. The patients showed 12 and 7 episodes of bloodstream and pulmonary infection, respectively. The D-index, days of neutropenia (<500/microL) and days of profound neutropenia (<100/microL) had at least a nearly significant impact on the development of both bloodstream and pulmonary infections. On the other hand, the c-D-index, cumulative days of neutropenia, and cumulative days of profound neutropenia significantly affected pulmonary infection, but not bloodstream infection. The c-D-index had a high negative predictive value of 97.4% for pulmonary infection with a cutoff of 5500, but the area under the receiver operating characteristic curve was similar to that of the cumulative days of neutropenia and profound neutropenia. Our results showed that although the c-D-index may be useful for identifying patients who are at low risk for early pulmonary infection after HSCT, its performance was similar to that of the simple duration of neutropenia.Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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